To investigate the effect and safety of early intervention and delayed intervention therapy on elderly patients and younger patients with non-ST segment elevation acute coronary syndrome. The patients with non-ST segment elevation acute coronary syndrome were randomly divided into early intervention group (coronary angiography taken within 24 hours after grouping) and delayed intervention group (coronary angiography taken after 36 hours after grouping). The primary endpoint was a composite endpoint of death, myocardial infarction and stroke during 180 days follow-up. A total of 815 patients were enrolled, including 198 elderly patients aged 75 years and above, and 617 younger patients aged below 75 years. The elderly patients had a greater incidence of the primary endpoint than that of younger patients (P = 0.00). The primary endpoint of early intervention group were obviously lower than that of delayed intervention group of younger patients (P = 0.01). There was no significant difference in primary endpoint incidence of early intervention group and delayed intervention group of the elderly patients (P = 0.39). The elderly patients with non-ST segment elevation acute coronary syndrome who underwent intervention had greater incidence of death and myocardial infarction. Early intervention reduced the rate of myocardial infarction for the younger patients. There was no significant difference in primary endpoint incidence between early intervention and delayed intervention among elderly patients.
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Backed by rich private investors, proton therapy, a highly precise but expensive form of radiation used to treat cancer, is booming in China. The country has gone from having no operating proton therapy centers two and a half years ago to having two in operation today plus at least 43 more proton projects in various stages of development, according to China Particle Therapy News, an industry newsletter.
“Proton therapy is going into overdrive,” says Zeng Xianwen, a leading radiation oncologist with 60 years of experience in the field. Zeng is positive on the development but cautions that the treatment is not a cure-all.
Advocates hold that proton-beam therapy is better than conventional radiation treatment based on X-rays because protons release most of their energy on the tumor and then stop, causing less damage to nearby healthy tissue. And researchers, including Zeng, are looking for ways to further improve the therapy by minimizing its impact on skin and other tissue the radiation travels through to reach the tumor.
But studies of proton therapy have been limited, and their authors say more work in this area is needed. For example, a 2014 study of childhood brain tumor survivors supports the idea that proton therapy may lead to a better quality of life for patients when compared to conventional radiation, but its authors say more study is needed to prove that. Another paper published earlier this year concludes that despite its higher cost, proton therapy “offers promising cost-effectiveness” for childhood brain tumors and some types of breast, lung, and head and neck cancer. This study, however, was based on limited data, and its authors warn that the conclusion could change as more evidence becomes available.
Proton centers are far more expensive to build than conventional radiation suites. Traditionally centers cost hundreds of millions of dollars to build. Even new, more compact designs cost between $25 million and $30 million per system.
Rather than stemming from demand from the medical community, this building spree in China originates from the country’s shifting economic winds. Chinese investors have seen returns from traditionally lucrative stakes in manufacturing and real estate decline in recent years, and that has made investment in medical centers, particularly ones focused on a cutting-edge technology, an area of increasing popularity, says Yu Hongxia, general manager of APH Medical, a subsidiary of a medical supplies company that is investing 1.6 billion yuan ($240 million) in a proton center in southeastern China.
Further encouraging this interest is a 2015 decision by the government to relax restrictions on the importing of medical equipment. That made it easy to purchase proton-beam systems from foreign manufacturers.
Some worry these centers could further worsen the existing disparity of health care between what the rich and well-connected receive and the average citizen. Although detailed pricing information for the new centers is not yet available, it is certain to be expensive. The going rate for an average treatment at a proton center in Shanghai, one of two operating today, is 278,000 yuan ($41,636). Patients pay for that out of their own pocket. No insurance policy covers proton therapy in China today.
Others question whether China has the medical expertise needed to staff so many centers. Some of the hospitals that have teamed up with private investors to build proton centers have never had radiation oncology departments, and there are few professionals experienced with providing proton therapy. As a result, Hu Yimin, chief medical physicist at Cancer Hospital Chinese Academy of Medical Sciences, worries that patients may suffer. “We should develop proton therapy, but not in such haste,” he says.
Chao, a 28-year-old who underwent proton therapy treatment two years ago, would argue the centers can’t open quickly enough.
In early 2014, when a doctor told her that a rare cancerous tumor nestled at the base of her skull had begun to grow again after two surgeries, Chao, who declined to have her full name published in order to protect her privacy, says she didn’t know what to do. A second doctor suggested proton therapy, but it wasn’t then available in China.
That fall, her family scratched together 200,000 yuan ($29,954) and took her to a cancer center in Japan for treatment. “I was lucky,” says Chao, seated recently in her brightly lit office in Beijing. Her tumor is no longer growing, and she’s working full-time again.